- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $239.88 / $3,388.44
| Facility | | $54.95 | $239.88 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $53.70 / $74.13
| Professional | | $52.48 | $53.70 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $107.15 / $181.97
| Facility | | $52.48 | $107.15 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $52.48 / $89.13
| Professional | | $52.48 | $52.48 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $83.18 / $125.89
| Professional | | $72.44 | $83.18 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $91.20 / $114.82
| Facility | | $47.86 | $91.20 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $45.71 / $45.71
| Professional | | $45.71 | $45.71 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $52.48 / $77.62
| Professional | | $44.67 | $52.48 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $69.18 / $69.18
| Professional | | $69.18 | $69.18 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $53.70 / $93.33
| Facility | | $41.69 | $53.70 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $51.29 / $77.62
| Facility | | $48.98 | $51.29 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $51.29 / $77.62
| Professional | | $48.98 | $51.29 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $87.10 / $114.82
| Facility | | $52.48 | $87.10 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $52.48 / $56.23
| Professional | | $51.29 | $52.48 | $56.23 |